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Resources

HHS-OIG Contacted Me – What Steps Should I Take?

If HHS-OIG contacts you, immediately secure specialized healthcare defense counsel and institute a company-wide document hold. Contact from the Department of Health and Human Services – Office of Inspector General (HHS-OIG), whether via subpoena, phone call, or surprise visit, requires urgent, strategic intervention to help prevent irreversible damage to your practice. Actions to Take Immediately [...]

A Guide to Responding to a Medicare Additional Documentation Request (ADR)

If your practice just received a letter labeled “Additional Documentation Request,” you’re not alone — and you’re not necessarily in trouble yet. An ADR is one of the most common tools Medicare contractors use to review whether a claim was billed correctly. But how you respond in the coming weeks can determine whether that claim [...]

Defending Federal Bank Fraud Charges: What You Need to Know

When a financial institution flags suspicious activity such as falsified loan documents, forged checks, unauthorized account access, or a scheme to obtain funds through deception, the matter often moves quickly from an internal bank investigation to a referral for federal prosecution. Bank fraud is a serious felony and strikes at the integrity of federally insured [...]

Defending Federal Tax Fraud Cases: What You Need to Know About IRS Investigations 

When an Internal Revenue Service (IRS) civil audit reveals firm indications of intentional deception, the stakes escalate from financial penalties to the potential loss of freedom. Federal tax fraud and tax evasion are aggressively pursued by the Internal Revenue Service Criminal Investigation Division (IRS-CI) and the Department of Justice (DOJ) Tax Division. These agencies employ [...]

What Is a TPE Audit? Understanding Targeted Probe and Educate Reviews

Pursuant to the Medicare Program Integrity Manual (Pub. 100-08), Chapter 3, Section 3.2.5, participating providers who fail to achieve acceptable error rates during Targeted Probe and Educate (TPE) audits may be subjected to 100 percent prepayment review, extrapolation, or referral to a Unified Program Integrity Contractor (UPIC) for further administrative action by CMS or its [...]

Chronic Care Management Billing Protocols – a Guide to Challenging DOJ Audit Data

Chronic Car Management is In the DOJ Spotlight. Explore Our Guide to Defending Your CCM Practice During a Healthcare Audit. [...]